New Treatments for Acute Leukemia
Acute lukemia is a hematopoietic progenitor cell malignancy. These cells proliferate in an uncontrolled fashion and ultimately replace normal bone marrow elements. Most cases arise with no clear cause. However, radiation and some toxins (benzene) are clearly leukemogenic. In addition, a number of chemotherapeutic agents (especially procarbazine, melphalan, other alkylating agents, and etoposide).
Most of the clinical findings in acute lukemia are due to bone marrow failure, which results from replacement of normal bone marrow elements by the malignant cell. Less common manifestations include direct organ infiltration (skin, gastrointestinal tract, meninges).
Acute lymphoblastic lukemia (ALL) comprises 80% of the acute lukemias of childhood. The peak incidence is between 3 and 7 years of age. However, ALL is also seen in adults and comprises approximately 20% of adult acute lukemias. Acute myelogenous lukemia (AML; acute nonlymphocytic lukemia [ANLL]) is chiefly an adult disease.
A. Symptoms and Signs: Most patients with acute leukemia present with an acute illness and have been ill only for days or weeks. Bleeding (usually due to thrombocytopenia) is usually in the skin and mucosal surfaces, manifested as gingival bleeding, epistaxis, or menorrhagia. Less commonly, widespread severe bleeding is seen.
Most young patients with acute leukemia are treated with the objective of effecting a cure. The first step in treatment is to obtain complete remission.
Acute myelogenous lukemia is treated initially with intensive combination chemotherapy, including daunorubicin and cytarabine. Effective treatment produces aplasia of the bone marrow, which takes 2B3 weeks to recover. During this period, intensive supportive care, including transfusion and antibiotic therapy, is required. Once complete remission has been achieved, several different types of postremission therapy are potentially curative. Options include repeated intensive chemotherapy, high-dose chemoradiotherapy with allogeneic bone marrow transplantation, and high-dose chemotherapy with autologous bone marrow transplantation. Recently, progress has been made in the treatment of acute promyelocytic leukemia (M3). The addition of all-trans retinoic acid to initial chemotherapy has improved the results of both initial treatment and long-term survival.
Acute lymphoblastic leukemia is treated initially with combination chemotherapy, including daunorubicin, vincristine, prednisone, and asparaginase.
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) a B lymphocyte (rarely T lymphocytes) clonal malignancy. The disease is usually indolent, with slowly progressive accumulation of long-lived small lymphocytes. These cells are immunoincompetent.
Chronic lymphocytic leukemia is manifested clinically by immunosuppression, bone marrow failure, and organ infiltration with lymphocytes. Immunosuppression, bone marrow failure, and infiltration of organs.
A. Symptoms and Signs: Chronic lymphocytic leukemia is a disease of the elderly, with 90% of cases occurring after age 50 and a median age at presentation of 65. Many patients will be incidentally discovered to have lymphocytosis.
Most cases of early indolent chronic lymphocytic lukemia require no specific therapy. Indications for treatment include progressive fatigue, troublesome lymphadenopathy, or the development of anemia or thrombocytopenia. These patients have either symptomatic and progressive stage II disease or stage III/IV disease. Initial therapy is with chlorambucil, 0.6B1 mg orally every 3 weeks. Complications such as autoimmune hemolytic anemia or immune thrombocytopenia may be treated with high-dose prednisone but Fludarabine is a new agent which is useful in treating disease refractory to The with aggressive disease may be a candidate for allogeneic bone marrow transplantation